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Öğe A new transodontoid fixation technique for delayed type II odontoid fracture: technical note(Elsevier Science Inc, 2009) Ozer, A. Fahir; Cosar, Murat; Oktenoglu, Tunc B.; Sasani, Mehdi; Iplikcioglu, A. Celal; Bozkus, Hakan; Bavbek, CengizBackground: A different transodontoid screw fixation technique Was studied in delayed type II odontoid fractures. This study presents observations oil a different transodontoid fixation technique to remove and decrease the amount of sclerotic layers to accelerate the Fusion process after the operation. Methods: Ten cases of chromic type II odontoid fractures, were operated oil via transodontoid screw fixation between 2000 and 2007 which were admitted 6 weeks or later after the trauma. Four of these 10 delayed patients were operated oil using a new anterior transodontoid screw fixation technique, whereas the other 6 delayed patients were operated On using, classical anterior transodontoid screw fixation. Results: Four delayed cases with type It odontoid fracture operated oil via this new technique had good results throughout the minimum 38 months' follow-up period. We did not observe nonunion, infection, and/or other complications such as vascular or brain-stern injury. Conclusion: Transodontoid screw fixation should be considered as a preferable treatment modality. This surgical intervention may be all alternative to conservative treatment even for cases with delayed type II odontoid fractures. (C) 2009 Elsevier Inc. All rights reserved.Öğe Anterior Approach to Disc Herniation With Modified Anterior Microforaminotomy at C7-T2 Technical Note(Lippincott Williams & Wilkins, 2009) Ozer, Ali Fahir; Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Cosar, MuratStudy Design. An easy surgical method to reach C7-Th and T1-T2 foraminal disc herniation is described. Objective. To describe a surgical technique that involves an anterior approach to disc herniation with inverted cone-shaped partial minicorpectomy. Summary of Background Data. Anterior approaches to the cervicothoracic junction are difficult in spinal surgery because the operative area is narrow. The manubrium, the clavicles, and the slope of the vertebral bodies obstruct the view of the surgeon. The vascular and neural structures of the superior mediastinum limit the surgical approach. The thoracic duct and recurrent laryngeal nerve present risks for injury, especially with approaches from the right side. Disc herniations at the C7-T2 level are very rare. Posterior approaches at these levels are advocated because radicular symptoms occur more often than myelopathic symptoms, but anterior discectomy and fusion are generally preferred by many spinal surgeons, as these are approaches that are more intuitive. Methods. We review the case histories of all of our patients that underwent inverted cone-shaped partial minicorpectomy and fusion at the C7-T2 disc levels between 2000 and 2008. We applied the surgical techniques described in this manuscript. Results. The mean follow-up duration was 50 months postoperation. Physical examinations were performed and radiographs were taken at the end of the first 6 months postoperative and every 12 months thereafter. No meaningful changes were recorded on either the Visual Analog Scale or the Neck Disability Index. Cervical alignment was unchanged before and after surgery. Conclusion. Minicorpectomy technique of C7 or T1 vertebra is an easy and appropriate method for treating foraminal disc herniation between the C7-T1 and T1-T2 levels.Öğe Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations(2010) Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Cosar, Murat; Ozer, A.F.Background: The observed rate of recurrent disc herniation after limited posterior lumbar discectomy is highest in patients with posterior wide annular defects, according to the Carragee classification of type II (fragment-defect) disc hernia. Although the recurrent herniation rate is lower in both type III (fragment-contained) and type IV (no fragment-contained) patients, recurrent persistent sciatica is observed in both groups. A higher rate of recurrent disc herniation and sciatica was observed in all 3 groups in comparison to patients with type I (fragment-fissure) disc hernia. Methods: In total, 40 single-level lumbar disc herniation cases were treated with limited posterior lumbar microdiscectomy and posterior dynamic stabilization. The mean follow-up period was 32.75 months. Cases were selected after preoperative magnetic resonance imaging and intraoperative observation. We used the Carragee classification system in this study and excluded Carragee type I (fragment-fissure) disc herniations. Clinical results were evaluated with visual analog scale scores and Oswestry scores. Patients' reherniation rates and clinical results were evaluated and recorded at 3, 12, and 24 months postoperatively. Results: The most common herniation type in our study was type III (fragment-contained), with 45% frequency. The frequency of fragment-defects was 25%, and the frequency of no fragment-contained defects was 30%. The perioperative complications observed were as follows: 1 patient had bladder retention that required catheterization, 1 patient had a superficial wound infection, and 1 patient had a malpositioned transpedicular screw. The malpositioned screw was corrected with a second operation, performed 1 month after the first. Recurrent disc herniation was not observed during the follow-up period. Conclusions: We observed that performing discectomy with posterior dynamic stabilization decreased the risk of recurrent disc herniations in Carragee type II, III, and IV groups, which had increased reherniation and persistent/continuous sciatica after limited lumbar microdiscectomy. Moreover, after 2 years' follow-up, we obtained improved clinical results. © 2010 Elsevier Inc.Öğe The Combined Use of a Posterior Dynamic Transpedicular Stabilization System and a Prosthetic Disc Nucleus Device in Treating Lumbar Degenerative Disc Disease With Disc Herniations(2008) Sasani, Mehdi; Aydin, Ahmet Levent; Oktenoglu, Tunc; Cosar, Murat; Ataker, Yaprak; Kaner, Tuncay; Ozer, Ali FahirBackground: Prosthetic replacement of spinal discs is emerging as a treatment option for degenerative disc disease. Posterior dynamic transpedicular stabilization (PDTS) and prosthetic disc nucleus (PDN) devices have been used sporadically in spinal surgery. Methods: This was a prospective study of 13 patients averaging 40.9 years of age with degenerative disc disease who underwent posterior placement of a PDN with a PDTS. The Oswestry low-back pain disability questionnaire and visual analog scale (VAS) for pain were used to assess patient outcomes at the 3rd, 6th, and 12th postoperative months. Lumbar range of motion was evaluated using a bubble inclinometer preoperatively and at 12 months postoperatively. Radiological parameters including lumbar lordosis angle (LL), segmental lordosis angle (?), disc height at the operated level (DHo), and disc height of the adjacent level (DHu) were evaluated. A typical midline posterior approach for complete discectomy was followed by the simultaneous placement of the PDN with PDTS. Results: Both the Oswestry and VAS scores showed significant improvement postoperatively (P < .05). There were no significant differences in LL, ?, DHo, and DHu parameters. We observed complications in 3 patients including 2 patients who had the PDN device embedded into the adjacent corpus; 1 had massive endplate degeneration, and the other experienced interbody space infection. In 1 patient, the PDN device migrated to one side in the vertebral space. Conclusion: The use of a PDN in combination with posterior dynamic instrumentation can help to restore the physiologic motion of the anterior and posterior column and could help to establish posterior dynamic instrumentation as an important treatment of degenerative disc disease. Theoretically this concept is superior, but practically we need more advanced technology to replace disc material. Because this study examined the combination of the PDN and stabilization instrumention, the results cannot be compared with those reported in the literature for either PDN alone or dynamic screws alone. Level of Evidence: Prospective cohort study with good follow-up (level 1b). © 2008 The Spine Arthroplasy Society.Öğe The major complications of transpedicular vertebroplasty(Amer Assoc Neurological Surgeons, 2009) Cosar, Murat; Sasani, Mehdi; Oktenoglu, Tunc; Kaner, Tuncay; Ercelen, Omur; Kose, K. Cagri; Ozer, A. FahirObject. Vertebroplasty is a well-known technique used to treat pain associated with vertebral compression fractures. Despite a success rate of up to 90% in different series, the procedure is often associated with major complications such as cord and root compression, epidural and subdural hematomas (SDHs), and pulmonary emboli, as well as other minor complications. In this study, the authors discuss the major complications of transpedicular vertebroplasty and their clinical implications during the postoperative course. Methods. Vertebroplasty was performed in 12 vertebrae of 7 patients. Five patients had osteoporotic compression fractures, I had tumoral compression fractures, and I had a traumatic fracture. Two patients had foraminal leakage, I had epidural leakage, I had subdural cement leakage, 2 had a spinal SDH, and the last had a split fracture after the procedure. Results. Three patients had paraparesis (2 had SDHs and I had epidural cement leakage), 3 had root symptoms. and I had lower back pain. Two of the 3 patients with paraparesis recovered after evacuation of the SDH and subdural cements however, I patient with paraparesis did not recover after epidural cement leakage, despite cement evacuation. Two patients with foraminal leakage and I with subdural cement leakage had root symptoms and recovered after evacuation and conservative treatment. The patient with the split fracture had no neurological symptoms and recovered with conservative treatment. Conclusions. Transpedicular vertebroplasty may have major complications, Such as a spinal SDH and/or cement leakage into the epidural and subdural spaces, even when performed by experienced spinal surgeons. Early diagnosis with CT and intervention may prevent worsening of these complications. (DOI: 10.3171/2009.4.SPINE08466)Öğe Utilizing Dynamic Rods with Dynamic Screws in the Surgical Treatment of Chronic Instability: A Prospective Clinical Study(Turkish Neurosurgical Soc, 2009) Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Cosar, Murat; Ozer, Ali FahirAIM: In this study, we examined the results of utilizing the agile posterior dynamic stabilization system with dynamic transpedicular screws in our patients. MATERIAL and METHODS: Posterior dynamic instrumentation with agile rods and dynamic transpedicular screws was employed in 15 (seven male and eight female) patients (mean age = 42, ranging from 30 to 53). The average follow-up duration was 19 months (ranging from 12 to 25). The primary purpose for the surgery was degenerative disc disease. For subjective evaluation, patients underwent a physical examination utilizing the Oswestry disability index (ODI) and visual analogue scale (VAS). Radiographic parameters, including the angle of lumbar lordosis (LL), angle of segmental lordosis ( cc) and intervertebral space (IVS), were also evaluated. Both subjective patient evaluations and radiographic parameters were assessed at the 3rd and 12th postoperative months. RESULTS: Significant postoperative improvements were observed in the ODI and VAS measurements (P<0.05). There were no significant differences in the LL, alpha and IVS parameters. One patient experienced a broken screw. CONCLUSION: We obtained good clinical results by utilizing dynamic rods with dynamic transpedicular screws.Öğe Utilizing Dynamic rods with Dynamic screws in the surgical treatment of chronic instability: A prospective clinical study(Turkish Neurosurgical Society, 2009) Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Cosar, Murat; Ozer, Ali FahirAim: In this study, we examined the results of utilizing the agile posterior dynamic stabilization system with dynamic transpedicular screws in our patients. Material and Methods: Posterior dynamic instrumentation with agile rods and dynamic transpedicular screws was employed in 15 (seven male and eight female) patients (mean age = 42, ranging from 30 to 53). The average follow-up duration was 19 months (ranging from 12 to 25). The primary purpose for the surgery was degenerative disc disease. For subjective evaluation, patients underwent a physical examination utilizing the Oswestry disability index (ODI) and visual analogue scale (VAS). Radiographic parameters, including the angle of lumbar lordosis (LL), angle of segmental lordosis (?) and intervertebral space (IVS), were also evaluated. Both subjective patient evaluations and radiographic parameters were assessed at the 3rd and 12th postoperative months. Results: Significant postoperative improvements were observed in the ODI and VAS measurements (P<0.05). There were no significant differences in the LL, ? and IVS parameters. One patient experienced a broken screw. Conclusion: We obtained good clinical results by utilizing dynamic rods with dynamic transpedicular screws.
